The Current State of Interoperability

How APIs are opening up a world of opportunity for healthcare

By Mohannad Hammadeh, an exhibitor at the HIMSS Interoperability Showcase™ at the 2018 HIMSS Global Conference & Exhibition, and product owner, APIs & Ecosystem, Orion Health

Interoperability is an opaque word. Officially defined, interoperability is the ability of different information technology systems and software applications to communicate, exchange data and use the information that has been exchanged. Simply put, interoperability is the ability to share information across multiple technologies.

And, it’s crucial in healthcare. Health information is, for the most part, trapped in siloed systems.

Think about every time you visit your primary care provider (PCP) and he/she records notes into their own electronic health record (EHR). Where does that information go? The answer is nowhere, unless it is transcribed into a referral and sent to a specialist. And even then, it’s only partial information that is included – not the entire medical record.

So, what happens if you go out of state and visit a different PCP, or get sent to the emergency department of your local hospital? What information is readily accessible for practitioners there to understand you, your conditions, your medical or family history?

Achieving Plug-and-Play Interoperability and Expanding Access

Currently, this is extremely limited. There is no “shared care record.” Information about you exists in multiple EHRs so no one has the complete picture of your health upon which to make treatment decisions or implement preventative courses of action.

Around the world, clinicians and managers in medical organizations – healthcare providers and health insurers – are fighting to achieve plug-and-play interoperability by unifying organizations to bring about change.

Healthcare is out of step with other industries: we can access our money from ATM machines anywhere in the world; we can send text messages to any mobile network; and we can use applications to service myriad needs (whether dietary, fitness or entertainment) on our smart phones. But they’re still keeping paper notes in some hospitals.

That’s why things must change. Today’s lack of interoperability compromises patient safety; impacts care quality and outcomes and ultimately wastes billions of dollars every year.

Context is Critical

But it’s complex. A clinical record can contain more than 100,000 different data fields and elements including numeric data, structured text, unstructured text and scanned files and images. Often EHRs have also been tinkered with by internal IT departments to evolve software products to a specific organization’s needs – which means different data fields have been defined that aren’t necessarily the same as what a comparable EHR has.

To get these different systems talking to each other – exchanging data – context is critical. Without the correct context, medical professionals can overlook information.

Today most data sharing is based on sharing some data fields with contextual integration or sharing view-only document summaries. Industry standards have been developed to make data sharing less clumsy but a non-uniform approach to the application of these standards remains a hurdle for interoperability.

Interoperability is crucial to deliver the business capabilities that we need in healthcare – inside and outside healthcare organizations – such as an electronic shared care record, automatic alerts and notifications by text, seamlessly transferring information between and within care settings, delivering remote care, analyzing data for population health management and resource optimization.

The Part APIs Have to Play in Improving Interoperability

Open application programming interfaces (APIs) are programming routines or protocols that allow software applications to share data, invoke business logic or perform an action – such as send a notification, map data, calculate and return a risk score, and start a workflow. They are ubiquitous in most aspects of modern day life.

APIs originally emerged in software as a great way for companies and vendors to share the functionality they’ve built in their proprietary application with a wider set of developers. They enable the abstraction of data, without giving away how that data is released – thereby protecting the source code of the application. But until recently, APIs have been glaringly absent in healthcare.

In the past, in the absence of reusable and well understood connectivity protocols, authentication frameworks, data models and the design patterns that APIs provide, developers had to reinvent the wheel and repeat work for each new integration. The knowledge, time and effort required to do this created high barriers, meaning healthcare integration became a specialist and expensive field. The complexities and costs involved in any subsequent upgrades meant that legacy systems hung around until well past their prime, and the industry as a whole could not easily and cost effectively adopt technology innovations.

Yet now APIs are favored as a way to standardize the way applications can access data. In part, this has been driven by EHR vendors pushing the ability to connect standalone EHRs, but also by collaborations such as Health Level 7 International (HL7) Fast Healthcare Interoperability Resources (FHIR).

Building an Effective Healthcare Ecosystem

The time and cost involved in sharing data through APIs is much less than traditional systems. So, what are the benefits of APIs? And how will they empower niche services in healthcare? APIs will do this by enabling connectivity and expansion, and driving innovation.

To build a healthcare ecosystem that truly serves the delivery of perfect healthcare for every individual, challenges around interoperability and APIs must be tackled head on. Open APIs can, and will, revolutionize healthcare delivery through empowering patients and enabling cross community collaboration between traditional healthcare providers as well as new players.

APIs play a huge role in opening up a healthcare platform to external applications, allowing data to be shared across different care settings. Developers need to see the value in investing their time into building these applications on top of a current platform and APIs alone aren’t convincing enough.

App developers will look for:

  • A platform with a large global reach
  • Quality APIs that are based on industry standards
  • Documentation that they can quickly and easily access
  • A sandbox where they can quickly validate and test their ideas
  • Tools which can help speed up their development
  • A community they can turn to for support

 

With these tools, the sky is the limit. Developers have access to everything they need to make healthcare smarter, break down health information silos and build valuable solutions that truly serve the delivery of perfect healthcare for every individual. #EmpowerHIT

Experience more up-and-coming digital health innovations at the HIMSS Interoperability Showcase™.

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